Is a pathology report of fragments of viable and non-viable cartilage and bone with areas of necrosis in a diabetic foot infection patient consistent with osteomyelitis (infection of the bone)?

From the Guidelines

Yes, the pathology result is consistent with osteomyelitis. The description of "fragments of viable and non-viable cartilage and bone with areas of necrosis" indicates bone death, which is a hallmark of osteomyelitis, as noted in the 2016 IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes 1. While the pathology report does not specifically mention bacterial infection, osteomyelitis is characterized by bone destruction and necrosis resulting from infection. In diabetic foot infections, osteomyelitis is a common complication, particularly when amputation is required, with a prevalence of ~50-60% in hospitalized patients and ~10-20% in ambulatory settings 1. The absence of bacteria in the pathology report doesn't rule out infection, as organisms may not always be visible in tissue samples, especially if the patient received antibiotics prior to surgery. Key points to consider in the management of this condition include:

• Treatment for diabetic foot osteomyelitis typically includes a 4-6 week course of antibiotics targeted at common pathogens like Staphylococcus aureus, Streptococcus species, and gram-negative organisms, as recommended by the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections 1.
• The specific antibiotic regimen should be based on culture results if available, or empiric coverage if not.
• Surgical debridement, as already performed with the toe amputation, is an essential component of treatment.
• Close monitoring of the surgical site, glycemic control, and appropriate wound care are also crucial for successful management of this condition. It is essential to prioritize the patient's morbidity, mortality, and quality of life when managing diabetic foot osteomyelitis, and to consider the potential need for revascularization, adjunctive measures, and multidisciplinary foot care teams to improve outcomes 1.

From the Research

Pathology Report Consistency with Osteomyelitis

• A pathology report of fragments of viable and non-viable cartilage and bone with areas of necrosis in a diabetic foot infection patient is consistent with osteomyelitis, as it indicates bone infection and necrosis, which are characteristic of osteomyelitis 2.
• The presence of necrosis and viable and non-viable cartilage and bone fragments suggests a chronic infection, which is often seen in diabetic foot osteomyelitis 3, 4.
• The diagnosis of osteomyelitis is typically confirmed by a bone sample examination obtained by either surgical or percutaneous biopsy, which can show evidence of bone infection and necrosis 2.

Diagnostic Criteria for Osteomyelitis

• Osteomyelitis should be suspected in patients with diabetic foot infections, especially in severe cases, and can be diagnosed using a combination of clinical signs, laboratory tests, and imaging studies 2.
• A positive probe-to-bone test, elevated inflammatory biomarkers, and abnormal imaging assessment using plain X-ray can be used to diagnose osteomyelitis 2.
• Sophisticated imaging examinations such as Magnetic Resonance Imaging (MRI) and nuclear imaging techniques can be used to localize the bone infection site and increase the diagnostic performance of percutaneous bone biopsy 2.

Treatment of Osteomyelitis

• The treatment of osteomyelitis typically involves a combination of antibiotic therapy and surgical debridement to eradicate the infection and preserve function 5.
• The optimal duration of antibiotic therapy for osteomyelitis is not well established, but a recent study found that a 3-week course of antibiotic therapy was non-inferior to a 6-week course in patients with diabetic foot osteomyelitis who underwent surgical debridement 6.